First, Do No Harm:Hippocratic or Hypocritical?

As the Republican Party fights to pass their health care bill (often called "RepubliCare"), which only 16% of the American people support, some Republican lawmakers are neglecting their moral and ethical obligations as physicians. That's right, there's a physician in the House -- 8 of them. There are 3 more in the Senate. All 8 of the House GOP physicians voted to approve the House bill. In the Senate, Dr. John Barrasso is one of the bill's chief architects and proponents. Dr. Rand Paul opposes the bill because it is not a full repeal of Obamacare. And Sen. Bill Cassidy has "concerns" about the bill which have nothing to do with access to health care.

Like any professional association, the American Medical Association has a Code of Medical Ethics with 9 guiding principles. Of these, "A physician shall support access to medical care for all people." However, the Congressional Budget Office (CBO) estimates that 22 million Americans would lose their health insurance under RepubliCare by 2026. Also from these guiding principles, "A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health." And yet RepubliCare would diminish public health on so many levels. Not one Republican has ever claimed otherwise. Because RepubliCare would be antithetical to the AMA's Code of Medical Ethics, the organization has written an open letter to oppose it in the strongest terms. If the AMA opposes the bill, shouldn't the physician-lawmakers?

A much more serious problem with the bill is that Americans would actually die from its passage -- lots of them. When people don't have insurance, they tend not to get checkups, have worrisome problems examined, or even take proper care of chronic conditions. Sometimes minor conditions become major ones, such as an untreatable cancer that could have been cured if caught early. How often do people die from not having insurance? Our best estimate probably comes from a 2014 study published in the Annals of Internal Medicine, which examined the effects of health care reform on death rate in Massachusetts. The authors concluded 1 death was prevented annually for every 830 adults gaining health insurance.

The math becomes pretty simple: Out of 22 million Americans who would lose their insurance, 26,506 Americans would die annually as a direct result of losing insurance under the RepubliCare program. That's more than the death toll from firearm homicides, HIV, and skin cancer combined. It's one September 11 attack every 6 weeks -- about a quarter the death rate we sustained in World War II. The personal share of this national death toll for each of the 51 Senate votes needed to pass this legislation would be 520 American lives per year. The same calculation for each of the 218 votes in the House would be 122 deaths per year.

The father of medicine, Hippocrates, had something to say about this. The Hippocratic oath, which every physician takes, says, "...I will abstain from all intentional wrong-doing and harm" (later restated, "First, do no harm"). This most fundamental guiding principle was featured prominently in the introduction of the AMA's letter.

What are we to think of a physician who would take away health care access from 22 million Americans?

And what are we to think of a physician who would knowingly cast a vote condemning so many Americans to die?

We should all tell our physician-lawmakers how we feel about their callous disregard for American lives. We've provided contact information, so that you can call, write, or even post comments to their Facebook posts: